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Anaphylaxis is a well recognised complication of many medications including rocuronium and PBVD. We fully agree with Drs Platt and Roberts that patients undergoing lymphatic mapping and sentinel node biopsy with PBVD must be informed of this small risk by the treating clinician during the consent process.
Our concern remains that patent blue V dye (PBVD) is being used without appropriate safeguards.
However, there are now multiple reports that confirm that PBVD, relative to its frequency of use, is associated with more allergic reactions than any other drug used in the operating theatre.
They refer to the excellent review by White and colleagues (3) that concludes that there is as yet no alternative effective strategy for sentinel node localisation and PBVD should not be abandoned.
Of particular relevance to PBVD, when the prevalence of sensitisation in the population is high, the predictive value is also high.
Most breast surgeons in Western Australia who use PBVD on a regular basis have direct experience of allergic reactions to this drug.
The principal author of this editorial (PP) has recently investigated a case of PBVD anaphylaxis when there was no informed consent, and the anaesthetist was not advised that PBVD was to be used.
There is no widely accepted Australian guideline for PBVD allergy screening.
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